A prospective evaluation of clinical and instrumental features before and after ventriculo-peritoneal shunt in patients with idiopathic Normal pressure hydrocephalus: The Bologna PRO-Hydro study

Giannini, Giulia; Palandri, Giorgio; Ferrari, Alberto; Oppi, Federico; Milletti, David; Albini-Riccioli, Luca; Mantovani, Paolo; Magnoni, Stefania; Chiari, Lorenzo; Cevoli, Sabina; Agati, R.; Calandra-Buonaura, Giovanna; Capellari, Sabina; Parchi, Piero; Maserati, Michelangelo Stanzani; Marliani, Anna Federica; Merola, Margherita; Piserchia, Vito Antonio; Sambati, Luisa; Sturiale, Carmelo Lucio; Supino, Antonella; Nicola, Monica; Urli, Tiziana

doi:10.1016/j.parkreldis.2019.07.021

Cited by 34 publications

(29 citation statements)

References 29 publications

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“…In our study, as previously reported in other studies [ 16 , 17 , 18 , 19 , 20 ], the gait and balance domain demonstrated the highest mean improvement rates. In contrast with previous studies [ 16 , 17 , 19 ], we noted a higher improvement for urinary incontinence and the neuropsychological domain. However, during follow-up, the cognitive functions continue to deteriorate, especially in patients with other mild neurodegenerative disorders.…”

Section: Discussionsupporting

confidence: 91%

“…However, during follow-up, the cognitive functions continue to deteriorate, especially in patients with other mild neurodegenerative disorders. Furthermore, controversy still exists on the reversibility of cognitive impairment, and several studies demonstrated that the gait domain has the highest improvement and impacts the total score the most [ 11 , 14 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The European Multicenter Study on NPH reported a good correlation between a newly developed assessment scale and the clinical improvement, providing a promising tool for the diagnostic process [ 11 , 12 ]. Several studies reported different protocols for the diagnosis and management of NPH [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Moreover, different diagnostic tests, such as extended lumbar drainage (ELD), the intracranial pressure monitoring (ICPM), infusion test (IT) and tap test (TT), have been used to predict shunt responders [ 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Shunting in Normal Pressure Hydrocephalus: A Multicenter Prospective Observational Study

Trungu

Scollato²,

Ricciardi

et al. 2022

JCM

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Background: Normal pressure hydrocephalus (NPH) is characterized by the triad of dementia, gait disturbance and urinary incontinence, all potentially reversible following a ventriculoperitoneal shunt (VPS). This study aims to evaluate the clinical outcomes of shunting in normal pressure hydrocephalus following a new standardized protocol. Methods: This study is designed according to the STROBE guidelines. Demographical, clinical, surgical and radiological data were collected from May 2015 to November 2019. Gait, balance and incontinence data based on the NPH European scale were collected before and after one, six and twelve months of treatment with a VPS. Clinical symptoms and changes of the stoke volume, measured on phase-contrast MRI, were used to evaluate improvement after VPS surgery. Results: One hundred and eighty-one consecutive patients met the inclusion criteria. The mean age was 73.1 years (59–86) and mean follow-up was 38.3 months (13–50). The gait (58.5 ± 14.3 to 70.1 ± 13.4, p < 0.001), the balance (66.7 ± 21.5 to 71.7 ± 22.1, p = 0.001), continence domain (69.9 ± 20.5 to 76 ± 20, p = 0.002) scores and neuropsychological scales showed a statistically significant improvement over the follow-up. The overall improvement after 12 months was present in 91.2% of patients. An overall complication rate of 8.8% and a reoperation rate of 9.4% were recorded, respectively. Conclusions: Surgical treatment by VPS for NPH improves symptoms in most patients, when accurately selected. A standardized protocol and a multidisciplinary team dedicated to this disorder is needed to achieve an early and correct diagnosis of NPH. Follow-up with stroke volume measurement is a valuable tool for the early diagnosis of shunt malfunction or the need for valve adjustment.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Shunting in Normal Pressure Hydrocephalus: A Multicenter Prospective Observational Study

Trungu

Scollato²,

Ricciardi

et al. 2022

JCM

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“…At first glance, it appears to be counterintuitive that patients with NPH and the AD + constellation improve upon CSF drainage. Recently, however, it was found that the positive effect of a spinal tap was related to amyloid changes in the brain on positron emission tomography 29 . Furthermore, patients with biomarkers of Alzheimer's disease showed a cognitive decline, although they were improved for ∼3 months after the spinal tap 30 .…”

Section: Discussionmentioning

confidence: 99%

Normal Pressure Hydrocephalus Associated with Alzheimer's Disease

Müller‐Schmitz

Krasavina‐Loka

Yardımcı

et al. 2020

Annals of Neurology

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The aim was to investigate whether neurodegenerative biomarkers in cerebrospinal fluid (CSF) differentiate patients with suspected normal pressure hydrocephalus (NPH) who respond to CSF drainage from patients who do not respond. Methods: Data from 62 consecutive patients who presented with magnetic resonance imaging changes indicative of NPH were studied with regard to cognitive and gait functions before and after drainage of 40-50ml of CSF. Additionally, S100 protein, neuron-specific enolase, β-amyloid protein, tau protein and phospho-tau were determined in CSF. Statistical analyses were carried out with ANOVA and multiple linear regression. Results: Patients with CSF constellations typical for Alzheimer's disease (n = 28) improved significantly in cognitive and gait-related functions after CSF drainage. In contrast, those patients without a CSF constellation typical for Alzheimer's disease (n = 34) did not improve in cognitive and gait-related functions after CSF drainage. In addition, positive CSF biomarkers for Alzheimer's disease predicted these improvements. Interpretation: Our data suggest an association between Alzheimer's disease and NPH changes, supporting the recently suggested dichotomy of a neurodegenerative NPH and a true idiopathic NPH, with the latter appearing to be rare.

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“…Patients with a clinical history possibly causing ventricular dilation, such as subarachnoid hemorrhage, meningitis, head injury, congenital hydrocephalus or aqueductal stenosis, were excluded. The diagnosis was assigned after reviewing: i) clinical data, ii) neuroimages, iii) neuropsychological information, and iv) blood and CSF composition tests during a consensus case conference comprising neurologists, neurosurgeons, neuropsychologists, neuroradiologists, physiatrists and nurses of the Institute of Neurological Sciences (IRCCS) of Bologna [26].…”

Section: Participantsmentioning

confidence: 99%

The effects of cerebrospinal fluid tap-test on idiopathic normal pressure hydrocephalus: an inertial sensors based assessment

Ferrari

Milletti

Giannini

et al. 2020

J NeuroEngineering Rehabil

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Background: Gait disturbances are typical of persons with idiopathic normal pressure hydrocephalus (iNPH) without signs distinctive from other neurodegenerative and vascular conditions. Cerebrospinal fluid tap-test (CSF-TT) is expected to improve the motor performance of iNPH patients and is a prognostic indicator in their surgical management. This observational prospective study aims to determine which spatio-temporal gait parameter(s), measured during instrumented motor tests, and clinical scale(s) may provide a relevant contribution in the evaluation of motor performance pre vs. post CSF-TT on iNPH patients with and without important vascular encephalopathy. Methods: Seventy-six patients (20 with an associated vascular encephalopathy) were assessed before, and 24 and 72 h after the CSF-TT by a timed up and go test (TUG) and an 18 m walking test (18 mW) instrumented using inertial sensors. Tinetti Gait, Tinetti Balance, Gait Status Scale, and Grading Scale were fulfilled before and 72 h after the CSF-TT. Stride length, cadence and total time were selected as the outcome measures. Statistical models with mixed effects were implemented to determine the relevant contribution to response variables of each quantitative gait parameter and clinical scales. Results and conclusion: From baseline to 72 h post CSF-TT patients improved significantly by increasing cadence in 18 mW and TUG (on average of 1.7 and 2.4 strides/min respectively) and stride length in 18 mW (on average of 3.1 cm). A significant reduction of gait apraxia was reflected by modifications in double support duration and in coordination index. Tinetti Gait, Tinetti Balance and Gait Status Scale were able to explain part of the variability of response variables not covered by instrumental data, especially in TUG. Grading Scale revealed the highest affinity with TUG total time and cadence when considering clinical scales alone. Patients with iNPH and an associated vascular encephalopathy showed worst performances compared to pure iNPH but without statistical significance. Gait improvement following CSF-TT was comparable in the two groups. Overall these results suggest that, in order to augment CSF-TT accuracy, is key to assess the gait pattern by analyzing the main spatiotemporal parameters and set post evaluation at 72 h. Trial registration: Approved by ethics committee: CE 14131 23/02/2015.

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A prospective evaluation of clinical and instrumental features before and after ventriculo-peritoneal shunt in patients with idiopathic Normal pressure hydrocephalus: The Bologna PRO-Hydro study

Cited by 34 publications

References 29 publications

Clinical Outcomes of Shunting in Normal Pressure Hydrocephalus: A Multicenter Prospective Observational Study

Clinical Outcomes of Shunting in Normal Pressure Hydrocephalus: A Multicenter Prospective Observational Study

Normal Pressure Hydrocephalus Associated with Alzheimer's Disease

The effects of cerebrospinal fluid tap-test on idiopathic normal pressure hydrocephalus: an inertial sensors based assessment

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